Riley psychiatrist testifies under immunity about girl's case

Dr. Kayoko Kifuji was granted immunity for her testimony. But it felt at times Monday as if the Boston psychiatrist herself were on trial.

John P. Kelly

Dr. Kayoko Kifuji was granted immunity for her testimony. But it felt at times Monday as if the Boston psychiatrist herself were on trial.

In her first public statements on the death of 4-year-old Rebecca Riley in December 2006, the Tufts Medical Center physician acknowledged frequently boosting the dosage of psychotropic drugs she prescribed to the girl and her older sister to treat bipolar and attention deficit hyperactivity disorders.

Carolyn Riley, whose murder trial entered its seventh day of testimony today, on some occasions increased her daughters’ drug dosages without approval, said Kifuji, who acknowledged refilling several prescriptions for the sedative clonidine before Riley’s previous supplies were scheduled to run out.

When Riley claimed to have lost a second bottle of clonidine in the summer of 2006, Kifuji said she scaled back prescriptions to 10-day supplies. Around the same time, Kifuji said, she refused a refill request when a Walgreens pharmacist told her Riley “has excuses” monthly for running low on the drug, which she used as a sleep aid for her children.

Prosecutors allege Carolyn and her husband, Michael Riley, who is being tried separately for murder, schemed to have their children diagnosed with mental illnesses to get federal disability benefits. And that Rebecca’s death – an autopsy showed it was caused by overmedication – resulted from reckless and negligent parenting.

Medical professionals from Springfield, where the Rileys lived until 2004, testified last week that Carolyn Riley made regular drives to Boston to see Kifuji after being unable to find a local psychiatrist willing to continue prescribing her older daughter clonidine and the mood-stabilizer Depakote. Social workers and a relative testified that Riley ignored pleas that she seek a second doctor’s opinion regarding the powerful drug regimen.

On Friday, Kelly Williams, who lived with the Rileys in late 2006, testified that the couple routinely gave Rebecca and her siblings their “sleeping pills” when they acted up in the evening. She said Carolyn Riley disregarded her repeated advice to take Rebecca to a doctor as her health deteriorated into bouts of vomiting and delirium.

Kifuji, a key witness, treated the Riley sisters and their older brother for bipolar disorder and other behavioral problems for a total of nearly four years.

For five hours Monday in Plymouth Superior Court, First Assistant District Attorney Frank J. Middleton Jr. grilled Kifuji in a chronological line of questioning that began with the older Riley sister’s bipolar diagnosis following the family’s first, 10-minute appointment with Kifuji in April 2003.

Kifuji said she relied on Carolyn Riley’s description of her 2-year-old daughter as physically aggressive toward her brother and an extensive family history of bipolar diagnoses that included Carolyn’s mother, son and husband. The girl also said she sometimes saw monsters and ghosts, Kifuji said.

The next year, Kifuji diagnosed Rebecca, then 2, with attention deficit disorder after her mother said she had become aggressive – “kicking and spitting” when disciplined – and hyperactive. Four days after Kifuji prescribed a maximum of one tablet of clonidine daily, Carolyn Riley reported back that she had increased the dosage to two tablets a day. Kifuji continued the higher dosage.

Kifuji diagnosed Rebecca in May 2005 with bipolar disorder, prescribing Depakote, after her mother said the girl had started having mood swings and trouble sleeping. Three weeks later, Kifuji said she received a request for medical records from the Social Security Administration, which Middleton said denied an earlier application for disability benefits related to Rebecca.

Prosecutors attempted to depict Kifuji as having a gullible level of trust in Carolyn Riley’s description of her children’s behavior. Middleton repeatedly referred to the doctor’s hand-written appointment notes, which often described Rebecca and her older sister as having a “bright affect” and being “happy.”

Kifuji, a slight woman who wore a charcoal suit and spectacles, kept her replies concise and her tone calm. She rarely elaborated and not once raised her voice. At one point, she stated flatly that the children “have mental illnesses.”

Questioning did grow tense at times.

“On Nov. 10, doctor, did you give 435 pills to the defendant to give that little girl?” Middleton asked, referring to three prescription refills – a one-month supply – that Kifuji approved on the second-to-last visit before Rebecca’s death.

Kifuji has practiced psychiatry in the United States since 1996 after emigrating from Japan, where she went to medical school. Initially, she faced possible criminal charges but returned to her Tufts practice after a period in which she agreed not to practice after a grand jury last summer did not return an indictment.

Defense lawyers will cross examine Kifuji beginning this morning.

Middleton portrayed several events in 2006 as warning signs that went unheeded by Kifuji.

In May, a social worker from Weymouth contacted Kifuji with concerns about Rebecca’s diagnosis and medication. That summer, a neurologist reported “dangerous levels” of Depakote in her older sister’s system after she was tested for hand tremors that made writing in school difficult. In November, a school nurse contacted Kifuji because Rebecca seemed heavily sedated, like a “floppy doll,” when she arrived to school.

John P. Kelly may be reached at jkelly@ledger.com.

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